I don’t advise you to hurry after arrival to the place. All hardships and trials will start when you climb in the mountains. You are still tired after the flight, have changed the time zone and the usual diet. It’d be better to spend 1-2 days having rest, sightseeing and talking to local people. Don’t drink alcohol and smoke hookah before a mountain hunt and don't forget to continue to take vitamins and adaptogens which you’ve started to take at home. It’ll be yours acclimatization - the best way to prevent altitude sickness.
It is scientifically proven that a man needs 1-3 days to adapt for an altitude. The hunter who didn’t finish the acclimatization process, has higher chances to get the altitude sickness.
The oxygen concentration on the sea level is about 21% and an atmospheric pressure is 760 mm Hg but as far as the height increases, the atmospheric pressure reduces and the air becomes more rarefied. We get just 50% from the oxygen norm when make a breath on the height 5500 meters. We should breathe more often to compensate the lack of oxygen; it means that our heart has to beat faster. But such intensive work of our body doesn’t help to get the needed oxygen concentration. About 20% of people who rise the height 2700 masl and more without the acclimatization has symptoms of altitude sickness. It can have different forms. The risk factors are the high speed of rising, the absolute altitude, excessive exercise, respiratory tract infections, chronic heart and lung diseases. A man who felt the mountain sickness once, has some predisposition to it, but the receptivity of different people or even one person can change and depends on different reasons and situations. Hypoxia (the lack of oxygen in the body) comes to the accumulation of fluid in human cells what is the core - the pathophysiological basis of altitude sickness.
Mostly we can see the acute mountain sickness (AMS) which manifest in 6-12 hours and even on the height 2000m.
The acute mountain sickness is characterized by headache, increasing when you seat or bend, dizziness, a feeling of "lightness in the head", increased fatigue and drowsiness, shortness of breath, nausea, edema, palpitations, impaired appetite and sleep. The symptoms may increase when you do something. It usually resolves itself in 72-96 hours.
The highlands pulmonary edema is a rare but very serious complication. It progresses in 48-72 hours after being on the altitude or even faster if the hunter has risen promptly on the height more than 2700m. The acute mountain sickness precedes to the pulmonary edema. The risk is higher for people who has stayed long on the height then goes down for a short period of time and climbs once again. It’s a typical situation for a mountain hunter who look for a sheep or chases the animal.
They also feel the increasing shortness of breath, fatigue, up to weakness, irritating cough with or without pink sputum. The other features of the pulmonary edema are increased respiratory rate (more than 20 times per minute), increased heart rate (more than 90 beats per minute), increased body temperature above 38 degrees, blue lips and fingertips, audible wheezing in the chest when breathing.
One more form of the mountain sickness is HIGH-ALTITUDE CEREBRAL (CEREBRAL) EDEMA. It is usually preceded by the acute mountain sickness symptoms which don’t resolve in 72-96 hours. It's characterized by constant headache that cannot be treated with analgesics, confusion and loss of orientation, drowsiness, poor coordination of movements when performing simple tasks, weakness and fatigue, blurred vision and double vision, gait disorders, swaying when standing with closed eyes, blue lips, fingertips, wheezing when breathing. The acute edema can come to the loss of consciousness, coma and death.
All forms of the mountain sickness, described above, are the state where one of the components can dominate.
The altitude sickness can be accompanied by hemorrhages in the retina of the eyes. In several situations we can see it even on the height from 2700m but it's almost normal when we climb to the altitude 5000 masl and more. It’s a common phenomenon without any symptomatic and passes without consequences. The hemorrhages in the nail bed areas or from the nose on the heights from 5000 m are quite rare. The peripheral edema of legs, arms or a face can connect with hard physical activity not only mountains sickness. They are not so dangerous as the other forms of the mountain disease but annoy and can inconvenience as the boots with wrong size, a wristwatches or rings can become tight and cause scuffs.
The influence of mountains appears not with the altitude only, the other factors which affect our condition, are ultraviolet radiation, wind, precipitation, temperature, and others. Low temperature and a strong wind increase the metabolism, the oxygen consumption increases and the oxygen starvation of the tissues worsens. That is the reason why the manifestations of altitude sickness can differ in dependence on the region.
The critical value to reduce the negative influence has not the medical issues but the right choice of the hunting equipment, boots, glasses and lotions. We shouldn't forget about high quality tents, sleeping bags, stove and others. Let’s come back to the medical theme.
What you should do if find that you or your friends have first symptoms of that disease.?
I suggest to decrease the speed of climbing or better to make a stop while the symptoms will resolve. Don't do anything rash and don't panic though the lack of oxygen can provoke you. Take a half of an hour rest in the safe place, take off the backpack, the carbine and take the comfortable position and drink some tea. When the unpleasant feelings will go away, you can go on moving but don’t’ forget to control breathing. It takes much time to train how to breath when moving in the mountains but you’d reduce fatigue, increase endurance and mileage of transitions, your internal well-being during transitions will become better after you make it. Unfortunately, the ability to breathe right is a skill which is very individual and nobody can recommend how to do it. It has no sense.
When you are going a whole day hiking or even more, the total load for a trained hunter shouldn’t be heavier than 22-25 kg. The total distance for a one day of hiking with the speed 2 km per hour should be about 15 km. We suggest to make stops each 35-40 minutes when rising by the gradient is to 12 degrees, if it’s from 12 to 20 degrees it’d be better to have rest each half of an hour and to make a pause in each 20 minutes if the steepness of the ascent is more than 30 degrees. Don’t forget to restore the normal rhythm of breathing and heartbeat each 10-15 minutes while climbing. Another way to plan the mountain route with the ascent of 12 degrees and more can be calculated by the heights difference, by vertical. The normal distance when you rise is about 300-350 meters per hour and 600-700 when you go down. It’s better to make a halt before climbing the most difficult parts. Lifting speed control is the best way to avoid the mountains sickness the same as the route planning and breath control. The modern medicine recommends to rise slow. It can take two days to ascend from the sea level to the altitude 2500 m and then 600 m per each day. It's import to sleep on the height which is higher than 300 in the previous night. It means that you should go down to the height 300 m plus where you have slept before even if you have climbed higher during a day. The mountain hunter could hardly follow these recommendations in comparison with the tourist or a climber. He doesn’t take a decision where to sleep, it depends on lots of reasons which we can't predicts. It’s clear that we can't foresee all circumstances but can try to reach the optimum and to reduce the number of accidents.
Good physical training and climbing experience don’t guarantee that you won’t suffer from the mountain sickness but they allow to work harder using less oxygen. I recommend you to avoid heavy physical activity during first days but the bed rest is less useful than the moderate activity. Our reactions to different activities are very individual that’s why you should define by yourself what climbing speed suits to you. If there are several hunters in one group the speed of moving is defined by the slowest member of the group.
Breathing of dry air on the height and physical activity lead to the loss of water. Dehydration of the body together with the lack of oxygen make you feel worse. It’s very important for a mountain hunter to drink enough. It’s better to drink more than usual. Each day you need to drink not less than 4-6 Liter. But you have to restrict the amount of salt to avoid edema. Alcohol and smoking can aggravate the acute of mountain sickness while the frequent intake of easily digestible food such as jams, carbohydrates and others, increase resistance to altitude sickness. I advise to eat them during first days on the altitude. I can write a lot about food in the mountains and it can take many pages. The short recommendation is to eat often and easily digestible food with a predominance of carbohydrates and vegetable proteins. A breakthrough in this area has been achieved in recent years in Russia at the junction of medical and food industries. The therapeutic nutrition became the base for a lot of products with 100% digestibility. They are made on the base of the vegetable protein and vitamin and mineral complex. They were specially produced for clients who experience high physical and psych emotional stress, work hard in tough conditions including mountains. The uniqueness of these products is in their ability to safe healing properties in the wide temperature diapason and in the convenient form of consumption – compact bars.
I wrote about the positive influence of adaptogens, biostimulants, vitamin and mineral complexes in the Part 1. You have to continue to take them in the mountains. Next time I’ll write about the positive preventive effect on the development of altitude sickness of other groups of drugs.
Sergey Rudnev, expert on certification of the ACC of the Ministry of Emergency Situations of Russia
